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General NPI Number Information
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NPI Number | 1205346574
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Entity Type | Organization
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Legal Business Name | MARYVILLE, INC
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1173 E LANDIS AVE
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City | VINELAND
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State | NJ
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Zip | 08360
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Country | US
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Telephone | 856-690-1000
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Fax | 856-690-1764
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Provider Business Mailing Address
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Address Line | 129 JOHNSON RD STE 7
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-1777
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Country | US
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Telephone | 856-863-3913
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Fax | 856-863-3917
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Authorized Official
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Title or Position | CFO
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Name | JARED LEVY
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Credential |
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Telephone | 856-863-3913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2000300
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License Number State | NJ
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